Publications

BACKGROUND

In this study, Pinto et al. identified significantly higher levels of neuron-specific enolase and Tau protein in older patients with sepsis-associated delirium in the emergency department, suggesting the potential of these biomarkers as diagnostic tools in this population.

OBJECTIVE

Sepsis-associated delirium is a common cerebral manifestation in patients with sepsis, potentially caused by a combination of neuroinflammation and other neurophysiological disorders. This study investigated the expression of neuron-specific enolase and Tau protein as biomarkers in patients with sepsis-associated delirium. While neuron-specific enolase and Tau protein are known to be associated with brain injury, their diagnostic potential in patients with sepsis-associated delirium is not well understood.

METHODS

This cross-sectional pilot study evaluated plasma levels of neuron-specific enolase and Tau protein in patients with delirium and sepsis to explore their potential for identifying sepsis in patients admitted to the emergency department.

RESULTS

A total of 25 patients with delirium were analyzed, 56% of whom had sepsis. Patients with sepsis exhibited significantly higher neuron-specific enolase levels (2.7ng/mL [95%CI= 2.2-3.2] versus 1.3 ng/mL [95%CI= 0.8-2.5], p<0.003) and Tau protein levels (96.1pg/mL [95%CI= 77.0-111.3] versus 43.0pg/mL [95%CI= 31.2-84.5], p<0.003) compared to patients without sepsis. Neuron-specific enolase and Tau protein thresholds of >2.08ng/mL and >59.27pg/mL, respectively, demonstrated 90% specificity for identifying sepsis in patients.

CONCLUSION

Neuron-specific enolase and Tau protein levels were significantly higher in patients with sepsis than in those without, underscoring their potential ability to identify the infectious etiology of delirium in older patients admitted to emergency departments. Clinical Trials #RBR-233bct.

BACKGROUND

■ Biomarkers of brain injury, such as neuron-specific enolase and Tau proteins, are higher in older patients with sepsis and delirium.

BACKGROUND

■ Diagnosing sepsis in patients with delirium can be challenging.

BACKGROUND

■ Early identification of sepsis is key to managing sepsisassociated delirium.

BACKGROUND

Despite the high prevalence of malnutrition in acutely ill older patients, nutritional status is rarely assessed in emergency departments (EDs), and the impact of nutritional risk screening on functional recovery is poorly understood. This study aimed to investigate the association between nutritional parameters and a range of outcomes in older patients admitted through the ED.

METHODS

A prospective cohort study was conducted at tertiary hospital, enrolling patients aged 65 years or older between November 2021 and April 2022. We collected data on various patient parameters, including demographics, clinical factors (Charlson Comorbidity Index [CCI], National Early Warning Score 2), nutritional status (Nutritional Risk Screening 2002; Global Leadership Initiative on Malnutrition criteria) and geriatric measures (Clinical Frailty Scale, Katz Index of Independence in Activities of Daily Living [ADL], Lawton and Brody Instrumental ADL, and PRO-AGE vulnerability tool). The primary outcome was functional recovery, and secondary outcomes included nosocomial infection, prolonged length of stay (LoS), in-hospital and postdischarge mortality, and hospital readmissions up to 6 months. Fine-Gray competing risks regression and multivariable logistic regressions were employed and adjusted for age, sex, education, CCI, functional status, LoS and initial allocation to intensive care.

RESULTS

A total of 780 patients (mean age 80 ± 9 years, predominantly male) were included, with 32.2% identified as at nutritional risk and 22.1% diagnosed with malnutrition. Patients with no nutritional risk had a higher significantly functional recovery up to 6 months (79% vs. 66%, sub-HR = 1.28, 95%CI 1.04-1.57, p = 0.029), whereas nutritional risk was independently associated with in-hospital (13% vs. 2%, OR = 4.24, 95%CI 1.53-11.74, p = 0.005) and postdischarge (14% vs. 4%, OR = 2.76, 95%CI 1.17-6.49, p = 0.02) mortality. Finally, malnutrition was independently associated with nosocomial infection (12% vs. 2%, OR = 5.43, 95%CI 2.56-11.5, p < 0.001), prolonged LoS (56% vs. 22%, OR = 2.79, 95%CI 1.84-4.22, p < 0.001) and postdischarge mortality (13% vs. 4%, OR = 2.76, 95%CI 1.36-5.61, p = 0.005).

CONCLUSIONS

Nutritional parameters were significant predictors of functional recovery, nosocomial infection, prolonged LoS and mortality in older patients admitted through the ED. Early identification and interventions targeting nutritional deficiencies should be explored to improve outcomes in this vulnerable population.

OBJECTIVES

To investigate the longitudinal evolution of physical and cognitive problems after hospital discharge in survivors of severe COVID-19; to describe the co-occurrence of these health problems domains in the following year after discharge; and evaluate if results are different taking into account the use of invasive mechanical ventilation.

DESIGN

Prospective cohort study.

SETTING

A large academic medical center in Brazil.

PARTICIPANTS

Patients aged ≥50 years who survived hospitalization for COVID-19 requiring critical care.

MEASUREMENTS

We evaluated participants' status before hospital admission and one, three, six, nine, and twelve months after hospital discharge using validated questionnaires to measure frailty, persistent physical symptoms, and cognitive function. Clusters of physical and cognitive problems were defined using sequential analysis. Concordance was studied between different problems and trajectories, and after stratifying for use of invasive mechanical ventilation during ICU stay.

RESULTS

We included 428 participants (median age was 63 years, 57% were male, 14% were frail before COVID-19, and 61% required mechanical ventilation). Physical and/or cognitive problems were experienced in 83% of responders at least once during follow-up, and half reported any problem even after one year. Most participants experienced health problems in a single health domain, with co-occurrence less than 9% in every assessment (Cramer's V bias-corrected less than 0.1 in any assessment). Sequential analysis identified three clusters each of cognitive and physical trajectories, with different evolution and no concordance. Stratifying the sample based on the use of mechanical ventilation did not change the results.

CONCLUSIONS

Severe COVID-19 survivors frequently experience physical and/or cognitive problems, yet these conditions and their trajectories are discordant. Multidimensional evaluations post-ICU discharge can aid in delivering tailored rehabilitation programs.